Shelto: A history lesson on health care reform

By Audrey Shelto/Guest Columnist

Sunday

Jun 17, 2018 at 4:52 AM

The heightened rhetoric in Washington about dismantling the Affordable Care Act leaves many across the nation anxious about the future of their medical care. We in Massachusetts can take some comfort in knowing that, whatever might happen in Washington, our own health reform law in Massachusetts will continue to cover our residents.

In April of 2006, “An Act Providing Access to Affordable, Quality, Accountable Health Care” became the law of the commonwealth, ushering in a host of provisions to ensure more comprehensive coverage and access to care through shared responsibility among government, individuals and employers.

This law was the capstone in a series of milestones, major and minor, stretching back more than three decades, that brought us to where we are today. Massachusetts now has the highest rate of health insurance coverage in the country – north of 96 percent of residents.

The Blue Cross Blue Shield of Massachusetts Foundation recently undertook a review of key statutory and regulatory provisions, and one theme emerged: Massachusetts has long been committed to promoting access to comprehensive benefits and coverage.

One of the first steps taken to address uneven and insufficient coverage was to level the playing field for individuals with mental health conditions. A 1973 law requiring coverage of mental health services was among the first in the nation. In 1985, the U.S. Supreme Court ruled that states have the right to enforce their health coverage mandates, thereby ending a challenge to that 1973 law.

It’s hard to believe that, once upon a time, health plans were not all required to cover pregnancy and pregnancy-related conditions. In fact, many women in Massachusetts were forced to buy more costly “family” insurance coverage, before actually having a child, to obtain maternity benefits – until 1985, when the state Division of Insurance stepped in with a regulation mandating such coverage.

Eleven years later, in 1996, another wave of reform expanded access to health care by broadening Medicaid (MassHealth) eligibility and restructuring the small-group and non-group market – shoring it up with a number of requirements including guaranteed issue and renewal (insurance policies offered without regard to health status), standardized benefits and no exclusions for pre-existing conditions. The effect was an increase in the number of insurance carriers offering coverage in the non-group market.

These two actions helped low-income individuals get access to coverage through Medicaid and helped the self-employed and those working for small businesses get better access to coverage.

Why recount all of this history about health reform? Well, some might say that we are doomed if we do not learn from history, and what we have learned is that there are common themes – based on our decades of progress in Massachusetts – around extending coverage to all residents (we are close), promoting competition among insurance plans, and of course protecting consumers.

These historical themes also remind us not to take this progress for granted and provide us with valuable context in light of ongoing threats to the Affordable Care Act, which was modeled after Massachusetts’ health reform law and signed into law in 2010.

Here in Massachusetts, the policies that we have put in place were thoughtfully developed, largely to improve access to health care. We must be deliberate and judicious in contemplating changes at any level of government that could undermine the gains we have made.

Audrey Shelto is president of the Blue Cross Blue Shield of Massachusetts Foundation, a private, nonprofit organization whose mission is to expand access to health care for low-income and vulnerable people in the commonwealth.